Herniated Disks: What You Need to Know

Spinal disks, made up of a hard outer ring and a soft center, serve as padding between each of the stacked bones of the spine. A herniated disk refers to when the outer shell of a disk is cracked, and the soft nucleus at the center protrudes through that crack.

By Brian Beise

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Causes
Disk wear and tear is normal with aging—disks dry out and aren’t as flexible as you get older—but smoking, weight gain, repeated strain, and poor lifting mechanics can accelerate the process. Herniated disks can also result from an injury to the neck or back.

Symptoms
While some herniated disks cause no immediate symptoms, others result in sciatica, shoulder or arm pain, weakness, numbness, or tingling. The severity of the herniation does not directly correlate with pain, making accurate diagnosis difficult, but no less important.

Very rarely, untreated herniations can compress the nerve roots at the base of the spine. This can lead to loss of sensation in the thighs, back of the legs, and rectal area; loss of bowel and bladder control; and increasing pain, numbness and weakness. Anyone suffering these symptoms should seek immediate medical attention.

Diagnosis and Treatment
Diagnosis of a herniated disk usually involves gathering medical history, a basic physical exam, an X-ray, and an MRI or CT scan. The vast majority of herniated disks can be successfully treated non-surgically with rest, ice, heat, non-prescription pain medication, physical therapy, and chiropractic. However, if these have failed and you are suffering from extreme pain and/or neurological symptoms (like numbness or weakness in the legs or loss of bladder control), a surgery called microdiscectomy may be needed to remove herniated disk fragments.

A microdiscectomy is typically an outpatient or same-day procedure, and it can be done using a minimally invasive technique. A decision for or against the procedure should be  reached in conjunction with a spine surgeon.

Expert Advice: Surgery

“There are several reasons why people have surgery for a herniated disk. The most common is failure of non-operative modalities to improve buttock and leg pain. Another reason would be leg weakness that is getting worse. The microdiscectomy isn’t great for back pain, but it’s highly successful for buttock and leg pain. The procedure is minimally invasive due to improved microsurgical techniques. Restrictions are typically minimal and recovery is usually brief.”

Jay Jolley, M.D.,
Spine specialist and surgeon, Southeastern Spine

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